Copyright © 2003 by the European Society of Cardiology.
Regular Articles
Determinants of use and outcomes of invasive coronary procedures in acute coronary syndromes: results from ENACT
a Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18, France
b ANMCO Research Center, Florence, Italy
c Institut für Epidemiologie und Sozialmedizin, Universität Münster, D-48149 Münster, Germany
d Cardialysis BV, Rotterdam, The Netherlands
e Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
f Cardiovascular Research, Department of Medical and Radiological Sciences, The University of Edinburgh, Edinburgh, UK
* Corresponding author. Tel.: +33-1-4025-8668; fax: +33-1-4025-8865
E-mail address: gabriel.steg{at}bch.ap-hop-paris.fr
Received 18 October 2002; accepted 23 October 2002
Aims To explore the variations in the use of invasive coronary procedures after acute coronary syndromes.
Methods and results In the ENACT registry, use of invasive procedures was analyzed as a function of hospital type, country and patient characteristics among 2768 patients with acute coronary syndromes (731 with ST-segment elevation myocardial infarction (STEMI) within 12h of symptom onset, and 2037 with other acute coronary syndromes). Percutaneous coronary intervention (PCI) was more likely to be performed in teaching than in community hospitals, and in hospitals with, rather than without, catheterization facilities. There were marked country-to-country variations in the use of PCI during the index hospital stay, ranging from 8 to 67% after STEMI 
and from 9 to 44% after other acute coronary syndromes . The main independent predictors of the performance of PCI were the country rate of use of PCI and the hospital availability of PCI. For patients with other acute coronary syndromes, the risk of adverse events, assessed by the simplified TIMI-risk score, was not associated with PCI. Logistic regression analysis showed that lack of PCI was an independent predictor of in-hospital mortality (odds ratio (OR): 3.75, 
) after other acute coronary syndromes, but not after STEMI.
Conclusions The use of PCI after acute coronary syndromes appears related more to local practice and hospital characteristics than to patients' characteristics or risk.
Key Words: Acute coronary syndromes • Coronary angiography • Percutaneous coronary intervention
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